Provider Demographics
NPI:1427494376
Name:MARTIN, LISA KAY (CNA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:KAY
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8275 96TH AVE
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32967-3848
Mailing Address - Country:US
Mailing Address - Phone:772-321-7616
Mailing Address - Fax:
Practice Address - Street 1:8275 96TH AVE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32967-3848
Practice Address - Country:US
Practice Address - Phone:772-321-7616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA205750376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLW1156 65679OtherAETNA NAP KRAFT FOODS GRP 469670-27-103
FL$$$$$$$$$OtherSOCIAL SECURITY ACT MEDICARE